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Clinical Experience

Adolescent Medicine Fellowship

Our clinical training includes the following rotations which allow the fellow to obtain experience in assessment and management of acute and chronic diseases that affect the adolescent and young adult age group.

First year


The first year of fellowship is devoted to helping the new Adolescent Medicine Fellow acquire the foundational knowledge, skills, and attitudes required for the successful practice of Adolescent Medicine. As part of this year, the fellows will participate in the following clinical experiences:

This is primary teaching service of the Children’s Mercy Adolescent Medicine Fellowship and will form the backbone of the subspecialty training in outpatient Adolescent Medicine. During the first and second years of fellowship, fellows will spend 2 half days a week on the Adolescent Medicine Outpatient Consultation service. During this rotation the fellow will work with a multidisciplinary team of providers, nurses, social workers, child psychologists, translators, and respiratory therapists to provide consultative care to adolescents 12-21 years old who were referred to Adolescent Medicine for a variety of issues including: management of mood disorders, reproductive health services, disordered eating, substance use, and complex medical issues complicated by behavioral health concerns. Our main clinic is in the heart of Kansas City and serves as a Title X clinic for the surrounding community. We also have several satellite clinics in the surrounding suburbs where fellows may work as well.

The focus of this rotation is providing care as part of a multidisciplinary team for adolescents with eating disorders. Throughout the first and second years of fellowship, fellows will spend 2 half days a week in the eating disorder clinic of Children’s Mercy Hospital. In this clinic, the fellow will work with a multidisciplinary team of providers, nurses, social workers, child psychologists, and nutritionists to provide consultative evaluations and ongoing care to adolescents 12-21 years old with eating disorders including: Anorexia Nervosa and Bulimia Nervosa,. Fellows will learn how to evaluate adolescents and families with potential disordered eating, assess and manage the physiological effects of disordered eating, how to establish and maintain a therapeutic relationship with patients and families, and how to support the other members of the team caring for an adolescent with an eating disorder. Fellows will gain this experience by evaluation of new patients or chronic patients from another provider and providing ongoing longitudinal care for these patients and families under the supervision of experienced providers.

Eating Disorder/Adolescent Medicine Consultation Service:

The Eating Disorder Inpatient Service provides supportive care and nutritional rehabilitation for adolescents with eating disorders requiring short-term hospitalization who are followed for outpatient care in our eating disorder center or by other community providers. All patients are admitted to the Pediatric Hospitalist Team with the Eating Disorder Inpatient Service providing consultation. At the beginning of fellowship the fellow will complete a 4 week inpatient rotation on Eating Disorder Inpatient Service. During this rotation, the fellow will spend 5 half days a week working with an experienced Adolescent Medicine practitioner providing consultation on the management of hospitalized adolescents with eating disorders. During this rotation the fellow will learn about the evaluation, management, and disposition of hospitalized adolescents with eating disorders.

After the initial 4-week rotation, the fellow will be on-service every 6th week to cover the inpatient wards on weekends and holidays.  During the week on-call, the fellow will also be responsible for inpatient consultations and outpatient telephone consultations coming from community providers on eating disorders and other adolescent issues in conjunction with one of the Adolescent Medicine Staff providers.

During this 8-week rotation, the fellow will spend 1 half day a week performing procedures such as, subdermal contraceptive implant placement, intrauterine contraception placement, and placement of subdermal Gonadotropin Releasing hormone agonist implants under the direct supervision of a credentialed provider. At the end of this rotation and fellow will be able to perform these procedures independently with direct supervision immediately available. This rotation will occur in the main Adolescent Specialty Clinic at Broadway BLVD.

During this 12-week rotation, the fellow will spend 5 half days working with a multidisciplinary team of providers from Adolescent Medicine, Pediatric Endocrinology, and Nutrition. This experience will focus on the evaluation and management of women, age 12-21, with irregular menses and/or evidence of hyperandrogenism consistent with PCOS and related disorders. 

During this 12-week rotation, fellows will spend 1 half day a week working with a multidisciplinary team of nurses, social workers, child psychologists, pediatric endocrinologists, chaplains,  and adolescent medicine providers delivering gender affirming care to gender-variant, gender-questioning and transgender children under the age of 21. The fellow experience will focus on assessment of gender identity and sexual orientation, management of reproductive health issues, psychopharmacologic management of mood symptoms in this population, and prescription of gender affirming hormonal therapy.

During this 8-week rotation, fellows will spend 1-2 half days a week working with a team of Pediatric Gynecologists and Advanced Practice Nurses. The focus of this rotation is the evaluation and management of complex gynecologic disease in the adolescent age range including endometriosis, anatomic abnormalities, and care for adolescents with severe developmental disabilities.

During the 16-week rotation, fellows will spend 1 half day a month working with a multidisciplinary team of nurses, Pediatric Cardiologists, Child Psychologists, and Adolescent Medicine Providers. This experience will focus on the evaluation and management of adolescents and young adults with Orthostatic intolerance symptoms including patients with: dysautonomia, POTS, NMH, chronic fatigue, and non-cardiac syncope/near syncope.

During this 8-week rotation, fellows will spend 1-2 half-days a week working with multidisciplinary teams of Physical Medicine and Rehabilitation Specialists, Developmental and Behavioral Pediatricians, Endocrinologists Occupational and Physical Therapists, Urologists, Social Work, and Adolescent Medicine providers to deliver comprehensive management of Adolescents with Down Syndrome, Spinal Cord concerns, or Turner Syndrome. First year fellows will also attend quarterly meetings of the Children’s Mercy Hospital Transition Committee to gain more insight into the transition needs of medically complex children and tools available to facilitate this process. The focus of the fellow will be on management of reproductive health concerns, assistance with transition to adult care, and basic preventive care for these individuals.

This is a 16-week rotation focused on assisting the fellow develop skills in behavioral intervention and motivational interviewing of older school-aged children and adolescents within a clinic setting. This rotation meets 2 half days a week at the end of the first training year and is supervised by a clinical child psychologist.


Second year


The second year of fellowship is designed to allow the Adolescent Medicine Fellow to consolidate the skills learned in the first year of fellowship and expose the fellow to different systems of care for adolescents in the community. As part of this year, the fellows will participate in the following clinical experiences:

During the second year of fellowship, fellows will continue to spend 2 half days a week on the Adolescent Medicine Outpatient Consultation service and 2 half days a week in the eating disorder clinic. During the second year, the fellow will continue to practice under the supervision of a credentialed adolescent medicine provider but will take increasing responsibility for the evaluation and management plans.

Eating Disorder Unit/Consultation Service:

During the second year of fellowship, the fellow will continue to be on-service an average of every 6th week to cover the inpatient ward on weekends and holidays.  During the week on-call, the fellow will also be responsible for inpatient consultations and outpatient telephone consultations coming from community providers on eating disorders and other issues in conjunction with one of the Adolescent Medicine Staff providers.

During this 4-week rotation, fellows will spend 5 half days a week working at Crittenton Children's Center, a community inpatient psychiatric unit for adolescent aged patients. During this rotation fellows will work with a team of Child Psychiatrists, Psychologists, and social workers to perform evaluations and short-term management of adolescents with acute psychiatric disease.

This experience will begin with a 4-week rotation at Crittenton Children’s Center substance abuse program. During this portion of the experience, the fellow will spend 3 half days a week in the residential and outpatient chemical dependency treatment programs observing initial patient evaluations, group therapy, individual therapy, and family therapy. The fellow will also gain experience in use of medications to prevent relapse and to address underlying mental health issues. 

After completing the 4-week intensive experience, the fellow will transition to a 16-week rotation, also at Crittenton, where they will observe a weekly group chemical dependency treatment session and follow one group of adolescents through the treatment process.  This will allow the fellow to gain a greater understanding of the chemical dependency treatment process and watch the progression of a group of adolescents through the recovery process, including addressing relapse and social challenges. During this 16-week follow up period, the fellow will also observe substance use treatment at the Hilltop Residential Treatment Center as part of the Juvenile Justice Rotation.

During this 16-week rotation the fellows will spend 1 half day a week at the Jackson County Juvenile Detention Center and 1 half day a week at the Hilltop Residential Treatment Center.

The Juvenile Detention Center provides temporary and safe custody of juveniles who are accused of conduct subject to the jurisdiction of the Court who require a restricted environment for their own or the community's protection while pending legal action. Juvenile Detention provides detained adolescents a wide range of helpful services to support the juvenile's physical, emotional, and social development. Services include education; communication training; counseling; continuous supervision; and medical and health care services.

Hilltop is a residential treatment center operated by Family Court Services, which houses up to 20 adjudicated males and 10 adjudicated females. The minimum stay is approximately five months and the average is six months. Detainees receive psychiatric treatment; individual and family therapy; substance use treatment; health services; and educational services.

Working in these two facilities will give the fellows a better understanding of the impact of chronic disease, mental health issues, environment, and family function on criminal behavior. Fellows will also work with physicians, therapists, and juvenile justice staff on evaluation of youth with disruptive behavior. Fellows will also get exposure to the impact of detention on the system of healthcare, follow up planning, and access to resources.

During this 12-week rotation the fellows will spend 1 half day a week at the Children’s Mercy Clinic at University Academy.

University Academy is a tuition-free, K-12 college-preparatory charter public school in Kansas City, Missouri. University Academy serves approximately 1,000 students in kindergarten through 12th grade who reside in the Kansas City Missouri School District. New students are selected by lottery from families from the Kansas City area who apply for admission. Students form this school come from a variety of socioeconomic backgrounds. The school has a 100% graduation rate, was designated as a Blue-Ribbon School by the US Department of Education and has been recognized as one of the best high schools in the United States by US News and World Report for the last 7 years running. Fellows will work with two nurse practitioners, from the Children’s Mercy Division of Adolescent Medicine, and educators from the school to provide primary care to these students.
Working in this school-based health centers will give the fellows a better understanding of the impact of chronic disease, mental health issues, environment, and school resources on academic performance. Fellows will also work with educators on evaluation of school failure, assessing learning problems, and maximizing classroom engagement for adolescents with acute and chronic medical issues.

Synergy is a shelter for homeless and runaway youth in the Kansas City area. During this 12-week rotation, fellows will spend 1 half day a week providing medical care for these youth and observing the counseling, drug treatment, and rehabilitative services offered to these youth with a focus on harm reduction and transitioning the youth to stable, sustainable living situations. Fellows will also get exposure to the impact of homelessness on health, risk factors associated with homelessness among youth, healthcare risks associated with homelessness, and the impact of insurance coverage and the legal status of homeless youth on medical care for these individuals.  


Third year


The third year of fellowship is designed to allow the Adolescent Medicine Fellow to develop their own style of clinical practice, take on leadership roles in the fellowship, and tailor their educational experience to address the weaknesses identified through self-assessment or to support their future plans for after fellowship. As part of this year, the fellows will participate in the following clinical experiences:

At the end of the second year of fellowship, fellows will select a location or locations from a list of Adolescent Medicine practice locations provided by the fellowship for their Adolescent Medicine Subspecialty Practice during the third year of fellowship. The fellow will spend 2 half days a week for the entire third year providing consultative care at this location or these locations under the supervision of an Adolescent Medicine Provider.

Fellows will refine their teaching skills by spending 1 half day a week supervising clinical care provided by residents and medical students in the Teen Primary Care Clinic at Children’s Mercy. This clinic is a patient-centered medical home for patients 12-21 years old and serves as one half of the 4-week Adolescent Medicine rotation for Pediatrics and Medicine-Pediatric residents from Children’s Mercy Kansas City. Fellows will also be involved in creating and delivering didactic education on core adolescent medicine topics to learners at different levels at Children’s Mercy and in the community.

In this 8-week rotation the fellow will spend 4 half days a week working with providers from the Sports Medicine Fellowship at Children’s Mercy. This rotation will focus on the evaluation and management of non-operative orthopedic injuries in the adolescent age group.

In this 8-week rotation the fellow will spend 4 half days a week working with psychologists and sleep medicine providers from the Sleep Medicine Fellowship at Children’s Mercy. This rotation will focus on the evaluation and management of sleep disorders in the adolescent age group.

In this 8-week rotation the fellow will spend 3 half days a week working with psychologists and specialists from the Infectious Disease Division at Children’s Mercy. This rotation will focus on the evaluation and management of HIV in the adolescent age group.

In this 8-week rotation the fellow will spend 3 half days a week working with psychologists and headache specialists from the Child Neurology training program and the Headache Fellowship at Children’s Mercy. This rotation will focus on the evaluation and management of headaches in the adolescent age group using a variety or pharmacologic, behavioral, and alternative medicine treatment modalities.

The fellow will have 4-weeks of elective time during the third year of fellowship to engage in activities to round out the fellowship training or to prepare for future career goals. Fellows could elect to complete a MPH during fellowship, have more time on one of the previous rotations from fellowship or engage in training on other experiences available at Children’s Mercy including:

Cystic Fibrosis Clinic

Inflammatory Bowel Disease Clinic

Renal Transplant Clinic

Dermatology

Orthopedics

Psychopharmacology

Toxicology

Clinical Pharmacogenomics

International Medicine

Integrative Pain Management

Advocacy

Research Block

During this 8-week rotation the fellow will spend 1 day a week working with a board-certified Adolescent Medicine physician working in a community based, solo practice associated with the University of Kansas, School of Medicine. This rotation will expose the fellow to another Adolescent Medicine attending and offer them experience working in another system of care that is structured differently than Children’s Mercy. This rotation will also broaden the fellow’s exposure to patients from various socioeconomic and cultural background and add additional richness to discussions of clinic management, health care financing, and quality improvement initiatives.